NURSING AND MIDWIFERY TRAINING COLLEGE, KPEMBE

UTILIZATION OF CONTRACEPTIVES USE AMONG WOMEN OF REPRODUCTIVE

AGES IN SALAGA MUNICIPAL OF THE SAVANNAH REGION OF GHANA

BY:

SUBMITTED TO

NURSING AND MIDWIFERY TRAINING COLLEGE, KPEMBE

AFFILIATED TO

KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY, KUMASI

IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF

DIPLOMA IN REGISTERED MIDWIFERY

AUGUST, 2023
 DECLARATION

This is to declare that except for references to the literature sources which have been duly

acknowledged, this work was done through our own research under the supervision of Mr. Abu

Iddrisu Mohammed and that, it has neither been partly nor wholly presented anywhere.

CANDIDATE’S NAME INDEX NUMBER SIGNATURE DATE

………………………………………………………………. ……………………………… …………………… ………………

………………………………………………………………. ……………………………… …………………… ………………

………………………………………………………………. ……………………………… …………………… ………………

SUPERVISORS DECLARATION

I hereby declare that the preparation and presentation of the project work was supervised in

accordance with the guidelines and supervision of project laid down by Kwame Nkrumah

University of Science and Technology.

MR. ABU IDDRISU MOHAMMED ……………………. ……………………..

(Supervisor) Signature Date

MADAM SHIRLEY ISSAH …………………....... ………………………

(Principal) Signature Date

i
 ABSTRACT

The desire for sexual satisfaction and pleasure as opposed by its unintended consequences has

given rise to the use of Contraceptives. Contraceptive is a type of modern contraception, which is

used after unprotected sexual intercourse, following sexual abuse, misuse of regular

contraception or non-use of contraception. The main objective of this study was to investigate

the utilization of contraception use among women of reproductive ages in the Salaga

Municipality. The study employed the descriptive cross-sectional study with mixed method

approach. Data from this study was sourced from both primary and secondary. The main tool for

data collection was questionnaire

Data was analyzed using SPSS version 24 for the quantitative data. The study found out that

Close to 60% had ever used contraceptives while 44% women were currently using

contraceptives at the time the study was conducted. Use of emergency contraception (45.5%) and

oral pill (22.7%) were the commonest used among participants. The leading barrier to

contraceptive use was fear of side effects whiles the primary enabler of use is the fact that

contraceptives are affordable.

ii
 ACKNOWLEDGEMENT

Our thanks and gratitude’s go to the sovereign God for His love, mercies and guidance bestowed

upon us throughout our career.

Our sincere gratitude goes to our supervisor Mr. Abu Iddrisu Mohammed for his advice,

guidance, and support throughout this study.

We also take this opportunity to thank all the lectures of Kpembe nursing and midwifery

Training College, for their dedication, guidance, and support.

We also wish to express our gratitude to all the respondents of the study who have cooperated in

providing the required information.

Last but not least, we are also indebted to our families for their all rounded support throughout

the study period. To all who contributed in diverse ways, we say thank you and may the almighty

God richly bless you.

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   DEDICATION

We dedicate this work to our parents for their unflinching love, support in prayers, cash and in

kind throughout our education.

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Table of Contents
DECLARATION...............................................................................................................................................i
ABSTRACT....................................................................................................................................................ii
ACKNOWLEDGEMENT.................................................................................................................................iii
DEDICATION...............................................................................................................................................iv
LIST OF TABLES..........................................................................................................................................viii
LIST OF FIGURES..........................................................................................................................................ix
CHAPTER ONE..............................................................................................................................................1
1.0 INTRODUCTION.....................................................................................................................................1
1.1 Background of the study....................................................................................................................1
1.2 Problem Statement............................................................................................................................3
1.4. Objectives.........................................................................................................................................6
General objective.................................................................................................................................6
Specific objectives...............................................................................................................................6
1.5 Research Questions...........................................................................................................................6
CHAPTER TWO............................................................................................................................................7
2.0. LITERATURE REVIEW.............................................................................................................................7
2.1 Contraceptives: History and importance...........................................................................................7
2.2 Contraceptive Prevalence................................................................................................................10
2.3. Determinants of the use of contraceptives....................................................................................12
2.4. Individual characteristics................................................................................................................12
2.4.1 Age............................................................................................................................................12
2.4.2 Residence..................................................................................................................................14
2.4.3 Spousal characteristics and communication.............................................................................16
2.4.4 Education and religion..............................................................................................................18
2.4.5 Parity and Fertility desires........................................................................................................20
2.5. Socio-economic factors...................................................................................................................21
2.5.1 Income and poverty..................................................................................................................21
2.6 Socio-cultural factors.......................................................................................................................22
2.7 Sexual behaviors and norms............................................................................................................23
2.8. Provider Factors..............................................................................................................................24

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CHAPTER THREE........................................................................................................................................28
3.0. METHODOLOGY..................................................................................................................................28
3.1. Study design...................................................................................................................................28
3.2. Study Area......................................................................................................................................28
3.3 Study population.............................................................................................................................29
3.4. Study Variables...............................................................................................................................29
3.4.1. Dependent/outcome variable..................................................................................................29
3.4.2. Independent Variables.............................................................................................................30
3.5. Sampling size and Sampling Technique..........................................................................................30
3.6. Data collection/techniques.............................................................................................................31
3.7 Data analysis....................................................................................................................................31
3.8 Pre-Test of Data Collection Instruments (tools)...............................................................................31
3.9 Ethical considerations......................................................................................................................32
3.10 Dissemination of Results................................................................................................................32
3.11 Limitations.....................................................................................................................................32
CHAPTER FOUR..........................................................................................................................................33
ANALYSIS OF FINDINGS.............................................................................................................................33
4.0 Introduction.....................................................................................................................................33
4.1. Background Characteristics of respondents...................................................................................33
4.2: Women's Knowledge, level of knowledge and source of information on contraceptives..............35
4.3 Use of contraceptives among respondents.....................................................................................38
4.4 Barriers and enablers of contraceptive use.....................................................................................40
CHAPTER FIVE............................................................................................................................................44
5.0 DISCUSSION.........................................................................................................................................44
5.1 Knowledge on contraceptives..........................................................................................................44
5.2 Prevalence of contraceptive use......................................................................................................45
5.3 Barriers and enablers of contraceptive use.....................................................................................46
5.4 Limitations of the study...................................................................................................................48
CHAPTER SIX..............................................................................................................................................49
6.0 Conclusions......................................................................................................................................49
6.1 Recommendations...........................................................................................................................49
6.1.1 Practice.....................................................................................................................................49
6.1.2 Policies......................................................................................................................................50

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 6.1.3 Research...................................................................................................................................50
REFERENCES..............................................................................................................................................51
APPENDIX I................................................................................................................................................54
QUESTIONNAIRE........................................................................................................................................54

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 LIST OF TABLES

Table 1: Background and socio-demographic characteristics of respondents............................................34

Table 2: Use of contraceptives among women aged 15-40 years..............................................................39

Table 3: Barriers and enablers of contraceptive use...................................................................................42

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 LIST OF FIGURES

Figure 1: women’s level of knowledge on contraceptives.........................................................................36

Figure 2: women’s knowledge on contraceptives......................................................................................37

Figure 3: Women’s source of information on contraceptives....................................................................37

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 CHAPTER ONE

1.0 INTRODUCTION

1.1 Background of the study

Contraceptives refer to any family planning method used to prevent a pregnancy. This is

achievable by interfering with the normal process of ovulation, fertilization, and implantation

(Geske, Quevillon, Struckman-Johnson, & Hansen, 2015). The idea behind contraceptive is as

old as time itself; but for just as long, finding an effective method that anyone can easily access

has been the major hurdle to cross (Edgerton, 2018; Tone, 2020).

This challenge exists primarily because of the push-pull forces of various contextual factors

which can be socio-demographic, cultural, economic, religious or even psychological (Kamhawi,

Underwood, Murad, & Jabre, 2016; Soe, Than, Kaul, Kumar, & Somrongthong, 2018;

Williamson, 2018).

Access to family planning is both a human right and a socio-economic necessity. It is a human

right issue because every woman has the fundamental right to determine how many children she

wants and when she wants to have them (Miller, 2012). The socio-economic necessity flows out

of the fact that uncontrolled population growth will inevitably lead to overpopulation and its

attendant consequences of high unemployment and youth dependency, rampart poverty, high

child and maternal mortality, scarcity of resources like water that often leads to conflicts, and

general environmental degradation (Hinrichsen & Robey, 2017; Macpherson, 2015). As such,

easing access to family planning is a practical imperative.

1
Presently, the world’s population has exceeded 7 billion, and 1t is still growing at the rate of

1.13% per year (U.S. Census Bureau, 2015). Also, sub-Saharan Africa’s population has been

projected to increase from 860 million in 2010 to 1.96 billion in 2050 (Bongaarts & Casterline,

2013). This growth is based on a Total Fertility Rate (TFR) of 5.4 (Westoff, Bietsch, &

Koffman, 2013). In Ghana, population growth has been high with estimates of a 2.1% national

population growth rate in 2013, and a TFR of 4.2 (Ghana Statistical Service (GSS), Ghana

Health Service (GHS), & ICF Macro., 2015; World Bank, 2015).

These imply that although there have been an increase over the past 40 years in the prevalence of

contraceptive practice from less than 10% to 60%, and fertility reductions in developing

countries from 6 to about 3 births per woman, there are still distances left to cover in ensuring

universal access to family planning (Cleland, Bernstein, Ezeh, Faundes, Glasier, & Innis 2016).

Striving to attain universal access to reproductive health by the year 2015, The 1994

International Conference on Population and Development (ICPD) and the Millennium

Development Goal 5, both pledged to work to increase the growth in the prevalence of the use of

contraceptives, since both have formed embankments of political commitment and funding for

expanding the coverage of family planning globally. In sub-Saharan Africa, these have translated

to efforts such as information, education, and communication (IE&C) interventions, decreasing

cost of contraceptives and building better supply lines to assure access in the more remote places

(Chola, McGee, Tugendhaft, Buchmann, & Hofman, 2015; Mwaikambo, Speizer, Schurmann,

Morgan, & Fikree, 2015).

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Post ICPD-1994, Ghana has also undertaken several interventions to scale up the use of

contraceptives such as the introduction of Ministry of Health-led reproductive health and family

planning programs (to reduce maternal and infant deaths, increase the use of contraceptives

among women of reproductive age, promote and improve access to reproductive health service at

all levels of health care delivery), the Navrongo Community and Family Planning Research

project, Behavioral Change Communication (BCC) Health intervention, and the integration of

family planning and HIV services (Agyarko, 2013; Achana, Bawah, Jackson, Welaga, Awine,

Asuo-Mante, & Phillips, 2015).

However, while much of the attempts in Ghana have had some impact on the use of

contraceptives with an increase in contraceptive prevalence from 13% in 1988 (GSS et al., 1988)

to 27% in 2014 (GSS et al., 2015), it remains to be seen exactly if locally-sourced solutions that

take into consideration long-standing health disparities, would have greater impact on local

barriers, constructs and narratives around the use of contraceptives. Also, the factors and

circumstances that help in expanding the use of contraceptives among those who should use

them — women of reproductive age - are not totally understood in some local socio-cultural

contexts.

Therefore, this study was conducted to clear that uncertainty by determining what barriers exists

in the use of contraceptives, and what promotes the use in a largely rural district in Ghana.

1.2 Problem Statement

Globally, the use of contraceptives have increased from 55% to 63% between 1990 and 2010,

but Sub- Saharan Africa still has the lowest prevalence (31%) and is currently facing a problem

in fertility decline (Probability, Kantorova, Menozzi, Affairs, Nations, & National, 2015).WHO

3
indicates that in Africa, the proportion of women aged 15-49 reporting use of a modern

contraceptives has realized a slight increase from 23.6% in 2018 to 27.6% in 2014? (Cleland et

al., 2016)In Ghana, the 2014 Demographic and Health Survey indicates that the demand for

family planning is 57%, but only 47% of that need is being met (Ghana Statistical Service &

Ghana Health Service, 2015).This obviously shows that there are barriers to getting family

planning, with such barriers resulting in uncontrolled population increase of 30.4% between

2000 and 2010. This comes to confirm the GDHS reporting that maternal mortality rate is 380

deaths per 100,000 live births, a high youth dependence rate of 67% and also a sizable infant

mortality rate of 46 per 1000 live births ((Ghana Statistical Service, 2012; World Bank, 2014).

However, this saddening description must be balanced by the fact that contraceptive prevalence

in Ghana has increased from 13% in 1988 to 27% in 2014, while the TFR has dropped from 6.43

in 1988 to the current 4.2 reported in the 2014 DHS (GSS et al., 2015) and as such, a holistic

picture shows that some factors are leading to an increase in the use of family planning across

Ghana. However, the fact remains that even the current TFR and population growth rate is

unsustainable and if left unchanged will cause Ghana serious problem that may obstruct its future

development.

Yet, while it is accepted that a discrepancy exists between the desire to prevent unwanted

pregnancy among women of reproductive age and their actual use of contraceptives, it is still not

fully clear why they do not use contraceptives. While studies have been done in Ghana that have

sought to unravel this reason nationally (Crissman, Adanu, & Harlow, 2012; Doctor, Phillips, &

Sakeah, 2009; Cleland et al., 2006), there exist only little information on how health facilities

enable or hinder use, other provider behaviors and socio-economic factors affecting parts of

Ghana in relation to use of contraceptives with their specific contexts. Also, they have often not

4
provided an exhaustive understanding and relative importance of the determinants of the use of

contraceptive in many communities in Ghana.

This is especially true in Salaga Municipal where more than half of women demand for family

planning, but only a fourth of them have their needs met (Salaga District Health Directorate,

2015). To further highlight the gap in the use of contraceptives in Salaga, child spacing is poor

with one in four women giving birth again less than two years after a previous delivery. This has

led to a situation where the Salaga hospital recorded a total of 200 unsafe abortions and 34

maternal deaths between 2017 and 2015 (Salaga District Health Directorate, 2015)

Furthermore, the establishment of tertiary training institutions including the Nursing and

midwifery training school in Kpembe, in addition to two second cycle institutions in the Salaga

District has often been cited as among others being responsible for the high rate of abortions in

the District.

This study therefore tried to describe and analyze the rounded perspective about the obstacles

and enablers to the use of contraceptives and examine both socioeconomic and provider factors

affecting the family planning services women have access to. Understanding these relationships

will help develop culturally sensitive recommendations and key messages about strategies

towards meeting contraceptive needs of women in Salaga and other similar communities across

the nation.

1.3 Justification

The findings of this study provided essential information regarding family planning use in Salaga

Municipal, which intends to advise district level policy makers on what areas to set and

formulate the policies that would speed up wider adoption of contraceptives among eligible

5
women. It also informed programme developers on framing the objectives, activities and

expected outcomes form any program interventions targeted at improving contraceptive

prevalence in Salaga.

1.4. Objectives

General objective

To determine the utilization of contraceptives use among women of reproductive ages in Salaga

Municipal of the Savannah Region of Ghana

Specific objectives

1. To assess the knowledge of contraceptives among women of reproductive age

2. To determine the prevalence of contraceptive use among women of reproductive age

3. To identify factors serving as enablers and barriers to the use of contraceptives

1.5 Research Questions

1. Do women of reproductive age in Salaga know about contraceptives?

2. What is the prevalence of the use of contraceptives among women of reproductive age in

Salaga?

3. What factors serve as enablers and barriers to the use of contraceptives in Salaga?

6
 CHAPTER TWO

2.0. LITERATURE REVIEW

This section reviewed document relating to the topic 'the use of contraceptives among women of

reproductive age in Salaga Municipal'

The literature was organized based on history of contraceptives, knowledge of contraceptive

methods, barriers to the use of contraceptives and prevalence of the use of contraceptives among

women. Information for the review was obtained from; journals, books, online articles,

newspaper articles all obtained from various offline and online sources such as Google Scholar,

HINARI, PUBMED, Elsevier, Science Direct, Online Wiley Oxford Journals, SCOPUS,

SAGEPUB, Taylor and Francis and other databases.

2.1 Contraceptives: History and importance

It is important that at the beginning of a review of literature about contraceptives, it is explained

that contraceptives are essentially about preventing pregnancy and birth. As such, it stands as a

catch-all word for any method which is aimed at that singular purpose.

However, as this is an academic endeavor, it is vital to discuss contraceptives within the bounds

of academic literature.

Contraceptives are the methods of the family planning framework which allows program persons

and couples to define the number of children, when and at what interval to have them. (Intra

Health, 2015).

The concept of contraceptives and family planning, as earlier stated, is an old one. It rose out of a

universal need for people to enjoy sex and not be saddled with a pregnancy after the act; that is,

7
being able to space or limit births (Glasier, Gülmezoglu, Schmid, Moreno, & Van Look, 2016).

Methods such as celibacy, sexual taboos, abstinence, withdrawal (coitus interruptus), and

induced abortion were commonly used by many ancient societies (Frejka, 2018; Woods, Hensel,

& Fortenberry, 2019).

By the middle ages, barrier methods such as vaginal sponges and cervical caps were also used in

the Middle East including ancient Egypt several thousand years before the common-era, while

rock salts were used as spermicides (McFarlane & Grossman, 2014). In China, women drank

lead and mercury to control fertility, which often resulted in sterility or death (Reuben, 2014).

In the West, the combination of the witch-hunt and the great plague in medieval times helped

suppress birth control. But the articulated views and activities of Robert Malthus, Francis Place,

and later, Margaret Sanger and Marie Stopes led to the revival of the use of contraceptives

(McFarlane & Grossman, 2014). The 2 The 20th century witnessed an unprecedented expansion

in the use of contraceptives as it became increasingly clear that the prodigious increase in global

population explained by the demographic transition theory was unsustainable (Newson, Postmes,

Lea, & Webley, 2005; Reher, 2014).

It has become increasingly clear that contraceptives are indispensable with various studies

having shown the benefits of the use of contraceptives. Ahmed et al., (2017) found that

contraceptives were responsible for a 44% (272,040 lives saved with uncertainty interval

127,937-407,134) reduction in maternal deaths in 172 countries across the globe in 2008 and that

satisfying unmet need at that time would have led to a further 29% reduction (104 000 maternal

deaths avoidance) (Ahmed, Li, Liu, & Tsui, 2015). Another study buttressed this point by stating

that increasing use of contraceptives in developing countries in the 20 years previous to their

8
work has resulted in a 40% decline in maternal deaths, and each 1 percentage point increase in

the use of contraceptives reduces the maternal mortality ratio by 4-8 deaths per 100,000 live

births. They go further to say that two years spacing of children can translate into a 10%

reduction in the risk of death in infancy, and 21% in children of ages 1-4 years (Cleland, Conde-

Agudelo, Peterson, Ross, & Tsui, 2015). Reynolds et al., (2018) found that in 2008, unintended

HIV-positive births averted by use of contraceptives ranged from 178 in Guyana to over 120 000

(Reynolds, Janowitz, Wilcher, & Cates, 2008).

The MATLAB Controlled long-term studies in Ghana and Bangladesh also showed that better

access to contraceptives and increased use effects reduced fertility, improved birth spacing,

women's participation in the paid labour-market, earnings, assets, and body-mass indexes, and

also improved children's schooling and body-mass indexes (Canning & Schultz, 2016). In sub-

Saharan Africa, contraceptive implants alone have the potential to avert 1.8 million of the 14

million unintended pregnancies that occur annually (Hubacher, Mavranezouli, & McGinn, 2018).

In 2016, contraceptives used in developing countries were projected by the World Health

Organisation to have prevented 218 million unintended pregnancies, averted 55 million

unintended pregnancies and births, 138 million abortions (40 million of which were unsafe), 25

million miscarriages and 118,000 maternal deaths. Further, they estimate that meeting all unmet

need for family planning in the developing world would lead to the prevention of an additional

54 million unintended pregnancies, including 21 million unplanned births, 26 million abortions

(of which 16 million would be unsafe) and seven million miscarriages. Also, it would help avoid

79,000 maternal deaths and infant deaths of 1.1 million (Singh & Darroch, 2017). Cleland et al.,

(2016) underline the macroeconomic importance of the use of contraceptives in reducing

9
poverty, youth dependency and hunger, and restated how important it is in attaining the MDGs

(Cleland et al., 2006). As such, use of contraceptives is essential for many reasons.

2.2 Contraceptive Prevalence

Considering this clear importance of contraceptives, it is worthwhile to understand the

prevalence and pattern of contraceptive use, globally and in Ghana.

Around the world, the contraceptive options available to women have increased, a factor which a

review by Ross and Stover (2013) found as instrumental in the increased use of contraceptives

globally between 1982-2009 (Ross & Stover, 2013). Specifically, their review showed that the

availability of 1 method to at least half the population correlates with an increase of 4-8

percentage points in total contraceptive use.

Currently, there are two major classifications of contraceptives - modern contraceptives and

traditional contraceptives. The medically accepted modern contraceptives are the barrier methods

(both male and female condoms, diaphragms, cervical caps, contraceptive sponges and

spermicides), hormonal methods (combined oral contraceptives, progestin- only pills,

contraceptive patch, injectable birth control, vaginal rings, implantable rods), emergency

contraceptives, intrauterine methods (copper IUD and hormonal IUD) lactational amenorrhoea

method (LAM), and sterilization (tubal ligation, sterilisation implant and vasectomy). The

traditional methods are rhythm (or fertility awareness/periodic abstinence method), withdrawal

(coitus interruptus) and folk methods (other traditional culture-specific methods).

However, in studies and programs focused on family planning, traditional methods (which are

used even by highly educated, urban, non-poor women) are often discounted because of their low

effectiveness.

10
The United Nations in a 2013 report explain that globally, contraceptive prevalence is 63%, with

nine out of ten woman of reproductive age in a union who uses a contraceptives, relies on a

modern contraceptive (United Nations, 2013). The same report states that sub-Saharan Africa has

a prevalence of 25%, and that the most common methods worldwide are female sterilisation

(26%), IUDs (14%) and the emergency contraceptive (the pill at 9%).

In Ghana, the 2014 Ghana Demographic and Health Survey (GDHS) reports that contraceptive

prevalence among currently married women of ages 15-49 years is 26.7%, of which 22.2% was

from the use of modern contraceptives and 4.5% was from traditional methods. Among these

population, injectable (8.0%), implants (5.2%) and pills (4.7%) are the most commonly used

modern methods and rhythm method (3.2) which is the most common traditional method is more

used than male condoms (1.2%) (GSS et al., 2015).

In many developing nations, a method imbalance persists with a study of 123 countries by Ross

et al., (2015) showing that a single contraceptive method may account for as much as 50% of all

contraceptive use in that country (Ross, Keesbury, & Hardee, 2015). However, a broader mix

expands contraceptive method choice, allowing women choose the method that suits them best

and change methods as their circumstances and needs change (Skouby, 2014). As such in any

society, a poor method mix hinders the use of contraceptives, independent of prevailing high or

low contraceptive prevalence (Ross et al., 2015).

They were also able to identify trends in the use of contraceptives that aided expansion of use

such as the increased popularity of a previously underrepresented or new method, a decline in the

dominating popularity of a single method and the substitution of traditional with modern

methods ( Ross & Winfrey, 2016). Differences in the use of contraceptives pattern has also been

11
ascribed to social and cultural differences (Skouby, 2014). There are many such factors affecting

the use of contraceptives, and it would be fruitful to identify what such factors are.

2.3. Determinants of the use of contraceptives

Determinants of the use of contraceptives in this study refers to both barriers and enablers of the

use of contraceptives. Barriers, according to Shelton et al., (2013) are practices, derived at least

partly from a medical rationale, that result in a scientifically uncalled-for barrier to, or denial of

contraception (Shelton et al., 2013). Enablers are those which remove pre-existing obstacles and

helps increase the use of contraceptives. These two bifurcation of determinants are what this

study assessed. They were looked at from the Individual, socio-cultural and provider

perspectives.

2.4. Individual characteristics

These are the factors that are focused on the characteristic of the women. They include

demographic and obstetric characteristics

2.4.1 Age

The age of a woman has been found to be significantly associated with the use of contraceptives,

with older women generally less likely to use contraceptives than younger women. Blanc et al.,

(2019) found that in 40 developing countries, adolescents (aged 15- 19) were more likely to use

contraceptives than adult women, even though continuation rates were lower among them

(Blanc, Tsui, Croft, & Trevitt, 2019).

In the United States, women who were aged above 35 years were found by Frost et al. (2017) to

be more likely to use contraceptives with another study by Upson et al. (2019) confirming this by

finding that women aged 40-44 years were twice as likely not to use a contraceptive methods

12
when compared with a younger group (Frost, Singh, & Finer, 2017; Upson, Reed, Prager, &

Schiff, 2015).

However, in Uganda, modern contraceptive use was found to be much lower among younger

married women compared with older women (Asiimwe, Ndugga, Mushomi & Ntozi2014). The

class of older women in the study were aged 25-34 years and the comparative fat about 25-34

years.

This study also had other interesting findings, including the fact that age has indirect roles to

play in governing contraceptive use. While fertility desires among women aged 15-34 years

predicted contraceptive use, residence also predicted it among those aged 15-24 years, while

education level, household wealth did so among those 25-34 years (Asiimwe et al., 2014). Also,

a similar study found that age variations in perception on distance covered to access health

facility, listening to radio and geographical variances also influenced the use of contraceptives

(Asiimwe et al., 2014).

A multivariate logistic regression done in a study by showed that among women in Western

Ethiopia, age was an independent predictor of contraceptive use, with women aged 25-34 years

standing a double probability than other age groups to use modern contraceptive devices

(Tekelab, Melka, & Wirtu, 2015). Age was also found to be correlated to contraceptive use in the

Democratic Republic of Congo, with a Pearson correlation showing a negative correlation of

increasing age with ever use of contraceptives (Izale, Govender, Fina, & Tumbo, 2014).

A study in Angola had similar findings, showing that high educational level and living in the

capital region were strongly related with the use of contraceptives, whereas age below 20 years

was negatively associated with use (Decker & Constantine, 2018). In Ghana, a study using

13
bivariate analysis showed age as significantly associated with the ever use of modern

contraceptives (Aryeetey, Kotoh, & Hindin, 2016).

It can be inferred from literature focused on the developing world that women aged around 25–

34 years were most likely to utilize modern contraceptive methods than other age groups

(Borges, OlaOlorun, Fujimori, Hoga, & Tsui, 2015; Qazi, Hashmi, Raza, Soomro, & Ghauri,

2014; Stephenson, Baschieri, Clements, Hennink, & Madise, 2017; Tekelab et al., 2015). A

reason advanced for the difference in age-influenced contraceptive use is that usage is lower

among younger women because they are trying to delay or space births and have a stronger

fertility desires as such using contraceptives was not as pressing as for the older women who

want to limit their family size (Mehata, Paudel, Dotel, Singh, Poudel, & Barnett, 2014). Another

is that younger people have less self-efficacy and are often not as empowered (economically and

socially) as middle-aged people (who use more contraceptives) or are they free from fertility

expectations (much older people > 40 years), and as such have no significant say over their

reproductive health (Crissman, Adanu, & Harlow, 2012; Islam, 2014).

2.4.2 Residence

It is a well-known fact that urban dwellers generally fare better than their rural counterparts

across different health and development indicators (Clifton, 2015). The use of contraceptives is

not different, as the residence of a woman is a major predictor of her use of contraceptive, and

can act as both a barrier and an enabler of use (Mutangadura et al., 2017). Although there are a

few exceptions to the rule, such as Rwanda (where the gap is within the margin of error), this

rural-urban disparity often hold true across the developing world (Clifton, 2015).

14
While the gap between rural and urban usage of contraceptive has begun to shrink, it still

remains an important determinant in the developing world, especially sub-Saharan Africa. In

Bangladesh, Islam et al. (2013) found upwards of 3% difference in the use of contraceptives to

space and limit birth between urban and rural women with rural women being disadvantaged.

They also found in rural areas, twice the unmet need to space found in urban areas ( Islam, Islam,

& Rahman, 2013).

The findings of a study conducted in Osun state, south-western Nigeria showed that although

fertility was higher among urban women than rural women, only 16.8% of rural women used

contraceptives, as opposed to 46.7% of urban women (Olalekan & Olufunmilayo, 2015).

A study by Tawiah (2013) in examining maternal health care disparities in five sub- Saharan

Africa found that as at 2007, rural women were about twice less likely to use modern

contraception than their urban mates in Ghana and Kenya (Tawiah, 2013). This has led to a

situation where urban women in Ghana were found in a study, to be at lower odds of unintended

pregnancy than their rural counterparts (Johnson & Madise, 2018). However, the latest GDHS

shows that swift improvements have been made with the gap in contraceptive usage narrowing

from 16% in 1998 to 0.7% in 2014 (GSS et al., 2015)

This discrepancy might likely be a result of differences in the availability of contraceptive

sources (family planning clinics and medical facilities), preferred methods in the rural areas as

compared to the urban area (Ezeh, Kodzi, & Emina, 2014; Salinas, Al Snih, Markides, Ray, &

Angel, 2016). It could also be due to differences in fertility desires, as rural women may want

larger families than urban women who perceive a higher cost of having children and have

exposure to family planning ideation (Ezeh et al., 2016). A study that tried to determine current

modern contraceptive practices in Ethiopia, which found that compared to urban women, rural
15
women were about three times less likely to use modern contraceptive, also propounded that

rural-urban differences might speak to community level factors of socio-cultural acceptance of

contraceptives, independence with family relations and women empowerment which are

all .lower in rural areas (Bogale, Wondafrash, Tilahun, & Girma, 2014).

2.4.3 Spousal characteristics and communication

Spousal characteristics are key to the use of contraceptives by women, just as frequent

communication is also important. These characteristics centre on spousal education, religious

beliefs and income. A study went as far as to conclude that identifying barriers to use is best

done by looking at spousal characteristics than a woman's own (Clements & Madise, 2014).

A spouse's education is vital in determining a woman's contraceptive use. A study in Nepal

found that better educated spouses were likelier to use male sterilisation and condoms, with this

odds increasing when the spouse had higher education relative to the wife (Gubhaju, 2019). A

study by Uchudi (2018) that reviewed DHS data in sub-Saharan Africa made the finding that

lower educated women will not wish to discontinue childbearing without the support of a

husband with some education. But that as her education increases, the effects of the husband's

education wears off (Masudi Uchudi, 2013).

A paper by Bawah et al. (2015) that uses bargaining theory to interrogate the predictor influence

of women's relative income on contraceptive use posits that a woman's relative income to her

spouse's affects her contraceptive use. They point out that women who earn a higher income

relative to their spouses have higher "threat points”, and are more empowered to regulate their

fertility as they see fit (Bawah, Phillips, & Wak, 2015). This buttresses a finding in Nigeria that

women with higher education and income than their husbands were likelier to use contraceptives

16
than those of equal or lower income & educational stature to their husbands (Stephen & Enoch,

2014). A study in Ethiopia had a similar finding that showed that women who had

disproportionate education with their husband (higher or lower) used contraceptive more than

those on an equal footing (Tadesse, Teklie, Yazew, & Gebreselassie, 2013).

However DeRose and Ezeh (2015) made the finding that the spouse's education has a stronger

influence on the woman's fertility intentions and contraceptive use than her own education does

(Derosea & Ezeh, 2015). Also, it has been found in Ghana that the age of the spouse relative to

the wife's matters, as age differential increases, use of contraceptives decline (Oheneba-Sakyi &

Takyi, 2016).

A study in Burkina Faso found that a couple's education, wealth, place of residence and religion

are important predictors of contraceptive use by the woman. A fervently religious spouse who

has a negative perspective to contraceptive because of his religious belief, would discourage the

wife using such contraceptives. It also found that marital power and spousal communication

were important and significant predictors of contraceptive use (Klomegah, 2016).

The importance of spousal communication in contraceptive use in Ghana was identified early on,

as Tawiah's 1997 seminal (and in some ways pioneering) work on factors affecting contraceptive

use in Ghana showed that those who discussed family planning often were thrice as likely to use

contraceptives as those who never discussed with their husbands, and those who only engaged in

spousal discussion of family planning once or twice had twice the odds of using contraceptives

as those who never did .

Years after, these increased odds of using due to spousal discussion still holds, as evidenced by a

study that showed that women whose husband had a say in their reproductive health were 5%

17
point likelier to use modern contraceptives than those whose husband didn't have a say (Nketiah-

Amponsah, Arthur, & Abuosi, 2018).

Further underscoring this is a study by Johnson and Madise (2017) in Ghana showed that women

who engaged in spousal communication where less likely to have an unintended pregnancy;

further the odds of having such pregnancy lowered with increased frequency of spousal

communication (Johnson & Madise, 2017). A study in the Accra Metropolis by Boamah (2015)

reported that a major lack of communication between husbands and their partners on the

acceptance of contraceptive contributed to the low prevalence rate in the area. Importantly, a

longitudinal causality study in Navrongo, which asked if spousal communication predicted a

woman's contraceptive use, or if her use of contraceptives would be what generated the spousal

communication found that spousal communication consistently predicted contraceptive use

(Bawah, 2015). A study in Accra by Osei et al. (2014) found that women had supportive spouses

were more likely to continue using modern contraceptives regardless of fear of side effects than

those with non-supportive partners (Osei, Mayhew, Biekro, Collumbien, & Team, 2014).

Many women who fail to gain spousal permission also resort to covertly using GRI PRO ED

contraceptives, and according to Biddlecom & Fapohunda (1998), a survey in Ghana showed

that as much as 57% of contraceptive use is covert, with the spouse unaware of the woman's use.

However, such use had sometimes negative consequences on the women, especially when

economically dependent on the husband. Overall, Tilahun et al. (2014) as found, the husband's

favourable attitude towards family planning has a major role to play in a couple's use of

contraception (Tilahun, Coene, Temmerman, & Degomme, 2014).

18
2.4.4 Education and religion

As already stated above, a woman's education governs her contraceptive use, with higher

education correlating with higher odds of use, independent of spousal characteristics. Other

studies have further elaborated the association of a woman's education on contraceptive decision

making and choice as well as having an influence on women reproductive desires and behaviours

(Ali & Okud, 2013; Andalón, Williams, & Grossman, 2014; Asfaw & Gashe, 2014; Asiimwe et

al., 2014; Meskele & Mekonnen, 2014).

Concerning the role of religion in determining contraceptive use, a study in Cambodia, a deeply

Buddhist country, shows that religious belief has had little or no effect on the use of

contraceptives (Vathiny & Hourn, n.d.). A comparative study in Nigeria done on data 18 years

apart also confirmed the negligible influence of religion on the use of contraceptives (Wusu,

2014).

Tawiah's (2018) study on factors affecting contraceptive use in Ghana came out with the finding

that religion and culture did not affect use of contraceptives (Tawiah, 2018). The study gave a

possible reason that once a woman attains higher education, her ethnicity and religious affiliation

do not have a significant effect on her current contraceptive use. This was confirmed by Adanu

et al., (2019) whose findings revealed that religious affiliation did not affect contraceptive use in

Accra. They however, attributed a possible reason to the fact that Accra is an urban area (Adanu

et al., 2019). Women were able to make decisions regarding contraceptives use without the

influence of religion and culture. However, two studies in Pakistan, a Muslim country and

among Muslim minorities in India and Bangladesh was able to pinpoint religion as a substantial

influence on the knowledge and use of contraceptives (Farid-ul-Hasnain, Johansson, Gulzar, &

Krantz, 2013; Sahu & Hutter, 2012). Doctor et al. (2019) found that switching from traditional to

19
the Christian or Islamic faith in the Kassena-Nankana area of Upper East region in Ghana was

significantly associated with increased contraceptive use and decreased fertility (Doctor, Phillips,

& Sakeah, 2019). A study by Bawah et al., (2015) in Ghana also revealed that there is fear of

ancestral punishment with the use of contraceptives. Some women may want to desire to use

contraceptives but will not do so, because there is a belief among most of these women that their

ancestors are against the use of contraceptives, and that one may die or may not get any blessing

from the ancestors if she practices contraception ( Bawah, Akweongo, Simmons, & Phillips,

1999).

2.4.5 Parity and Fertility desires

The number of children a woman wants to have, as well as the number she successfully gives

birth to, are important markers of her contraceptive use, constituting enablers or barriers to it. A

study by Jaraman et al. (2019) found that in South Asia, when the number of children generally

but sons specifically increased, women's desire for children decreased and their use of

contraceptives increased (Jayaraman, Mishra, & Arnold, 2019). Another study in Bangladesh

had similar findings that showed that fertility decreased as the number of sons increased and

concerns on child and infant mortality decreased (Saha & Bairagi, 2017).

This indicates the role culture has in shaping fertility desires, where son-preference in Asia

can make women either perform sex-selective abortions or refuse to use contraceptives and keep

giving birth till they birth the number of sons they want (Westley, Choe, & Center, 2017).

This is also a phenomena found in sub-Saharan Africa, where a study in Nigeria among women

in polygamous marriages showed lower use of contraceptives if the women had no male child, or

had 3 or more female children (Audu et al., 2018). However, this is debunked somewhat by

20
Bongaarts (2013) when he explained that sex-selection while existing in north, west and central

Africa may actually correlate with higher contraceptive use (Bongaarts, 2013).

Another study that examined the role of community-level factors in explaining geographic

variations in modern contraceptive use in sub-Saharan Africa found that in East Africa, women

with no children were less likely to use modern contraception than multiparous women

(Stephenson et al., 2017). It however found such effects marginal in West Africa. This

corroborates a study in Ethiopia (in East Africa) where parity (the number of living children),

and religious norms were significant predictory factors of temporal and spatial patterns of

contraceptive uptake, with the risk of contraceptive uptake increasing by 40% with each

additional child (Alvergne, Gurmu, Gibson, & Mace, 2015).

In Ghana, Achana et al. (2015) showed that a couple's fertility preference and parity were

important determinants of contraceptive use in the Upper East region. They found that the odds

of contraceptive use among women who have 1-4 children is 2.62 times compared to women

with no children, and among those who had 5 or more children, was threefold the odds of use

among women who had no child (Achana et al., 2015).

A secondary analysis of DHS data in Ghana found that women who have experienced US

childhood mortality were found to use contraceptives less, and had significantly higher number

of additional children than those who hadn't (Gyimah & Fernando, 2014). In addition, a study in

Accra found that when couples reach their reproductive aims, they revert to using traditional

methods due to perceptions of chemical harm by modern contraceptives (Osei et al., 2014).

21
2.5. Socio-economic factors

2.5.1 Income and poverty

Poor women are usually dependent woman, robbed of the chance to take charge of their own

health choices. As such contraceptive use has been found to be more prevalent among women

who have high income in Ghana (GSS et al., 2015). However, given the fact that unintended

pregnancy, which implies low contraceptive use, is higher among poor women, there are studies

that show that poverty is not associated with contraceptive use, nor can it predict specific

contraceptive method choice (Foster et al., 2014; Frost & Darroch, 2018; Frost et al., 2017;

Upson et al., 2016). A study showed that women who work outside the home were more likely to

use contraceptives than those who were housewives (Palamuleni, 2013). However, Adanu et al.

(2019) found that in Accra, self- employed women were less likely to use contraceptives than

those in formal employment

2.6 Socio-cultural factors

Essential to the use of contraceptives is the knowledge of contraceptives, its methods and its

importance. Knowledge of contraceptives is very high around the world, with the Demographic

and Health Survey program of the USAID putting knowledge in the developing world as near

universal (Khan, Mishra, Arnold, & Abderrahim, 2017). A definitive estimate of knowledge in

Ghana, is that provided by the 2014 GDHS which puts na, is that provided by the 2014 GDHS

which puts knowledge of at least one method of contraceptive among men and women aged 15-

49 at 99%, with women knowing on average 8.5 contraceptive methods compared with an

average of 8.2 methods for men(Ghana Statistical Service & Ghana Health Service, 2015).

However, knowledge is governed by several factors such as income, residence, age and

education (Blanc et al., 2009; Palermo, Bleck, & Westley, 2014). It is important to note that

22
while knowledge of contraceptives is important in improving use as shown in as study by Cheng

et al., (2016), it does not assure use, as many know and do not use or begin use and discontinue

(Cheng, 2016; Lamvu, Steiner, Condon, & Hartmann, 2016; Mekonnen, Enquselassie, Tesfaye,

& Semahegn, 2014).

Beyond mere knowledge, there are attitudes and perceptions that influence use. Contraceptives

use are plagued with differing attitudes and perceptions that can hinder or enable its use. Some

perceptions gotten from a study in Malawi showed that perceptions of side effects, such as

prolonged menstruation, male impotence and genital sores, weight gain or loss, and infertility

hindered the use (Chipeta, Chimwaza, & Kalilani-Phiri, 2016). Also, attitudes towards pregnancy

and birth affects contraceptive use, as women who did not view avoiding pregnancy as important

were more than twice as likely not to use any contraceptive method (Frost et al., 2017).

However, a study in Nigeria found that women also show positive attitudes towards

contraceptives, stemming from challenging economic situation of the family or economic

aspirations, need to have time for personal development, desire to maximize child development,

desire to maintain health and avoid potential negative health consequences of high fertility

(Aransiola, Akinyemi, & Fatusi, 2014). The study as well as Cheng (2016) also showed that the

mass media and social network of the woman are also important as contraceptive use factors, as

the desire to imitate friends who are living happily and progressing well in their careers as a

result of limited number of children can influence increased contraceptive use (Aransiola et al.,

2014; Cheng, 2016).

Attitudes may be mediated by societal norms, such as high fertility expectancy from a woman,

beliefs that contraceptives are indicators of promiscuity and attitudes of cultural alienism to

contraceptive use that could incur ancestral wrath (Sedgh, Hussain, Bankole, & Singh, 2017).

23
Also, family members can be pressure points determining a woman's use of contraceptive, as

they may insist on a change in her parity status to fit their interests and social perception of

masculinity (Aransiola et al., 2014; Population Council', 2015).

2.7 Sexual behaviors and norms

This refers to prevailing sexual behaviour specific to societies and individuals. This includes

having multiple sexual partners, polygamy, and frequency of sexual encounters.

Studies show that women reporting multiple sex partners within a six month time period, were

almost half as likely to use any contraceptive as those who didn't report such, just as having

sexual intercourse equal to or less than once per month reduced the odds of using contraceptives

(Germek, 2016). Adanu et al. (2019) in their Accra population study found that women who has

more sexual partners were significantly more likely to use contraceptives than those with just one

sexual partner, but when adjusted for some socio- demographic factors such as age, household

size, marital status and education, only those with two partners remained significantly likelier to

use..

Further, a study has shown that women in polygamous homes were less likely to use

contraceptives than those in monogamous homes as they compete for children with mates, have

less frequent sex and adhere more to traditional beliefs about birth control (Palamuleni, 2013).

However, studies in Nigeria, Malawi and Ghana showed that being in a polygamous marriage

had no bearing on likelihood of using contraceptives until age and parity adjustments are made

(Achana et al., 2015; Audu et al., 2008; Baschieri et al., 2013).

24
2.8. Provider Factors

The availability of a contraceptive is integral to its use, and the factors contingent on the provider

of contraceptives are without doubt, very important.

At the very beginning of such considerations is defining the source of such contraceptives used.

According to the 2014 GDHS, Ghanaian users of contraceptives mainly obtained it from

government hospitals or polyclinics (29 percent) and government health centres or clinics (25

percent) while others got it from chemical or drug stores (22 percent) and pharmacies (7 percent)

(Ghana Statistical Service & Ghana Health Service, 2015). Understanding this is important

because an association between contraceptive source and use has been observed, with a study

showing that those who had a usual source of health care were 28.1% more likely to use

contraceptives compared to those who did not have a usual source (Germek, 2015). Also, women

who do not have a source of contraceptive services were less likely to use the pill and long-

acting methods, but more likely to use condoms relative to women who had a non-government

contraceptive source (Frost & Darroch, 2018).

In sub-Saharan Africa where the concentration of medical facilities as indicated by hospital beds

per 1000 people is as low and public transportation systems are poor, the distance to a

contraceptive source matters in contraceptive use (Obasi, 2013; World Health Organization -

WHO, 2014) This is especially relevant in the rural areas where distances to health facilities can

be long, meaning that women are less inclined to go such distances for contraceptives. However,

distances can also aid contraceptive use by women who are using without social and spousal

approval, as the distance gives them the desired confidentiality they desire

25
Also, waiting time to get the contraceptive is important. A study by Speizer et al. (2014) states

import that process hurdles such as the increase in a women's psychic and time loss due to

waiting for contraceptive services or requiring women to wait till their next menstrual period

before getting the contraceptive they desire has led to increased unmet need in Tanzania (Speizer

& Pearson, 2015).

If a woman endeavours to get to the source, it is also obvious that if she is not able to get the

method she prefers, she defers or stops use. A study in Vietnam showed that ready access to

contraceptives in terms of distance and method availability significantly increased the odds of

contraceptives use (Thang & Anh, 2016).

However, assuming a woman does get the method she prefers, she must be able to afford to get

it. Many times, in the procurement of modern methods of contraceptives, a fee is charged. For

many married women in their reproductive age (15-49 years) the cost of these contraceptives are

unaffordable (Creanga, Gillespie, Karklins, & Tsui, 2017).

In the developed world, cost is not much of a barrier, and an increase in cost might actually be

followed by increased use (Campbell, Sahin-Hodoglugil, & Potts, 2016). This problem occurs

mostly in developing nations like Ghana where many women of reproductive age are inhibited

from using contraceptives by poverty and financial dependence on their partners (Greene &

Stanback, 2018). However, some studies have shown that increased cost causes only small

reductions in use in the developing world, and in many surveys, financial cost does not often

place high among the reasons women do not use contraceptives (Campbell et al., 2016; Darroch

& Singh, 2013).

26
Respondents in rural Bangladesh were asked whether cost influences contraceptive use, the

respondent placed little emphasis on cost (Levin et al., 2015). Molyneaux (2016) as cited in

Matheny (2018) found that the increase in prices of contraceptives by 100% decreased its use by

only 3 to 5% (Matheny, 2014). Ciszewski and Harvey (1994) found, however, that an average

price rise of 60% for condoms in the Bangladesh social marketing program caused sales to drop

by 46% (Ciszewski & Harvey, 1994).

A study by Bawah (2015) showed that women cannot access contraceptive use because getting

money for these contraceptives could evoke conflict in their homes (Bawah et al., 1999).

Critical to a woman's use of contraceptive is the attitude of the provider. This is especially

important in conservative or religious cultures and among young users of contraceptives

(Biddlecom, Munthali, Singh, & Woog, 2017). The provider must also provide counselling and

advise on the use and possible side-effect and its management. The gender of the provider is also

a factor as observed in Pakistan, where a scheme known has the Lady Health Workers (LHW)

Programme has reduced a substantial part of the obstacles faced by rural dwellers in accessing

family planning services (Population Council', 2015). Essential to these is the provider's respect

of the clients' privacy and confidentiality. The provider's ability to give apt information

counselling services also predict client usage and continuity (Bongaarts & Bruce, 1995). Clients

may desire information about contraceptive methods available, usage procedures, risks, and side

effects which will dictate their satisfaction (Sedgh & Hussain, 2014). Studies have shown that

client’s desire information, and those who got such information and who had received

counselling were more likely to use contraceptives (Darroch & Singh, 2013; Darroch, 2013;

Sedgh & Hussain, 2014). Importantly, some providers exhibit provider bias, which means they

27
dictate the method to be useful to clients either clearly or by implications (Nalwadda, Mirembe,

Byamugisha, & Faxelid, 2010). This also affects contraceptive use.

Finally, some contraceptive providers demand tests and spousal approval before providing the

service: this may form an encumbrance to contraceptive usage (Sedgh & Hussain, 2014)

CHAPTER THREE

3.0. METHODOLOGY

This chapter describes study design, study area, variables, study population, sample size

estimation and sampling technique, data collection/technique, quality control, data processing

and cleaning, data analysis and ethical considerations procedures involved in the study.

3.1. Study design

This work employed a cross-sectional analytic study design which involved the use of

quantitative method of data collection.

28
3.2. Study Area

The study was conducted at Salaga Municipal Hospital in the Salaga Municipality of Savannah

Region. Salaga is one of the towns in the East Gonja Municipal Assemble. It is the largest

Hospital in the East Gonja Municipality. Salaga is suited in the Northern part of Savannah and

shares common boundaries with Kpandai District to the east, Nanumba North District to the

north and Brong Ahafo Region to the south. It’s the municipal capital. The town is surrounded

by several villages. Inhabitants in the Salaga community are mostly farmers.

29
3.3 Study population

Population has been defined by Denis et al (2015) as the entire aggregation of cases that meet a

designated set of criteria. The study population was pregnant women in the Salaga Municipal

Hospital between the ages of 17- and 40-years

3.4. Study Variables

3.4.1. Dependent/outcome variable

The outcome variable for this study is contraceptive use. This was measured by looking at

current use of contraceptives among women of reproductive age (15-49). This outcome variable

is binary in nature, which is either a woman in her reproductive age is currently using

contraceptives or not.

3.4.2. Independent Variables

In reviewing literature, some variables that were shown to have a significant association with

contraceptive use were included in this study. The independent variables for the study included

the following;

 Individual Factors: Socio-demographics, Parity, Gravidae,

 Socio-cultural factors: Knowledge of contraceptives, Ever-use of contraceptives, Family

opinion on use

 Provider Factors: Source of contraceptives, Process to get contraceptives, Cost of

contraceptive, Provider attitude, Privacy, confidentiality and discussion, Service quality

and satisfaction

30
3.5. Sampling size and Sampling Technique

The sample size consists of one hundred (100) selected women of reproductive age (15 – 49

years). This limited sample size was used because of time constrains and available resources.

The probability sampling method used in this study is simple random sampling. The simple

random sampling method was used to select the participants who were interviewed with

questionnaires. With the simple random probability method all participants had equal chance of

participating in the study information on the subject matter selected and it is less expensive.

On arrival in a household, a screening question was asked to identify eligible women. In order to

give equal chance to all the women in fertile age in a household where there was more than one

eligible woman, women were made to select from a basket containing pieces of papers with yes

or no. Anyone who selected yes and was willing to participate in the study was interviewed.

This continued until the total number of women of reproductive age needed were interviewed.

3.6. Data collection/techniques

For this study, questionnaires containing open ended and close ended questions were used to

collect data. The questionnaires were giving out to the study subjects to respond with the aid of

research assistants. The research assistant administered the questions to the respondent’s one at a

time. They read out the questions and interpret them to the respondents in the local language

(Gonja) after which the response from the respondents were recorded accordingly.

3.7 Data analysis

The data from the study was analyzed under the objectives of the study. The data was analyzed

in tabular and narrative form by sorting or grouping the data for easy processing. Quality control

31
checks were made to ensure that, follow-up questions were properly answered. The data for the

study was analyzed using SPSS version 21.

3.8 Pre-Test of Data Collection Instruments (tools)

The questionnaires were pre-tested at Salaga Municipal Hospital to assess it validity and

reliability. Ten (10) fertile women were interviewed and the data was analyzed. The results

guided the appropriate adjustments of the study tool. Every fault was redesign or replace after the

pre-test

3.9 Ethical considerations

Ethical clearance was obtained from the Municipal Health Directorate, after the school had given

the researchers the approval before the data collection. We met the chiefs, opinion leaders and

the respondents of the study community and their consent was sought for the study. In

consultation with the opinion leaders and chiefs, meeting was convened to formally introduce the

research team to the people in the community and explained to them the purpose of the study.

The purpose and the objectives of the study, and any potential risk or benefits inherent from the

study was explained to the respondents. The respondents were given the opportunity to ask any

questions about the study at any stage, and to withdraw from the study at any time. Privacy and

confidentiality were ensured by dealing with the respondents on individual basis.

3.10 Dissemination of Results

Copies of the final report of the research work were given to the Salaga municipal Assembly and

the Municipal Health Directorate to enable them make policies and decisions that would help

improve the coverage and use of contraceptives in the Municipal. A copy of the dissertation was

32
placed in Kpembe Nursing and Midwifery College library as literature source for academic

community.

3.11 Limitations

The study was limited to only women of reproductive age in the Salaga community. Due to the

time and financial constraints, the study did not cover every fertile woman in the community. In

the view of that, data for the study were collected from the study subjects chosen from the

community. A questionnaire written in English was used to collect the data and was interpreted

in the local language for some of the sample.

CHAPTER FOUR

ANALYSIS OF FINDINGS

4.0 Introduction

This chapter presents the analysis done to achieve the objectives of the study. It includes

Background characteristics of respondents, knowledge on contraceptives, use of contraceptives

among respondents, barriers and enablers of contraceptive use and quality of service delivery.

4.1. Background Characteristics of respondents

Table 4.1 presents the distribution of socio demographic characteristics. A total number of 100

women between the ages of 15-40 years were interviewed regardless of previous contraceptive

use, gravida and parity. The data were obtained in Salaga township and the Kpembe community

with sample size of 80 and 20 respectively

As shown in table 1, the largest section of respondents were in the age category of 21-25 years

33 (33.0%). After this followed the age category 26-30 years 25 (25.0%) whiles the least section

33
of respondents were found to be between the ages of 36-40 years 11 (11.0%). This age

distribution indicates that younger participants in the study are more.

Majority of the participants in this study were educated. It was recorded that 39 (39.0%) of

participants had senior high school (SHS) as their highest level of education. This was followed

by 22 (22.0%) who had attained Junior High School (JHS) education. Also, about one fifth of

respondents 20 (20.0%) obtained tertiary education, 9 (9.0%) had obtained primary education

whiles 6 (6.0%) had no formal education. A small section of the study population 4 (4.0%)

acquired middle school education.

In terms of employment status, only 34 (34.0%) were employed whiles the rest were not.

In relation to religious denomination, majority of the women 68 (68.0%) were Muslims followed

by 23 (23.0%) being Christians. 3 (3.0) were Traditionalist whiles 6 (6.0%) recorded no religion.

A greater proportion, 53 (53.0%) of women were not married, 38 (38.0%) were married, whiles 2

(2.0%) and 7 (7.0%) were widowed and divorced respectively.

A little above half, 63 (63.0%) women reported ever being pregnant of which 41 (65.1%) had 1

or 2 pregnancies whiles 22 (34.9%) reported having between 3 and 8 pregnancies. It was realized

that 40 respondents had given birth of which 29 (72.5%) of them gave birth to 1 or 2 children

whiles 11 (27.5%) of them gave birth to between 3 and 8 children.

Table 1: Background and socio-demographic characteristics of respondents

Characteristic Frequency Percentage (%)
(n=100)
Demographic characteristics
Age of respondents
15 – 20 10 10
21 – 25 33 33
25 – 30 25 25

34
31 – 35 21 21
36 - 40 11 11
Educational level of respondents
Primary 9 9
Middle 4 4
JHS 22 22
SHS 39 39
Tertiary 20 20
Never 6 6
Employment status of respondents
Employed 34 34
Unemployed 66 66

Religion
Christian 23 23
Muslim 68 68
Traditionalist 3 3
No religion 6 6
Marital status
Married 38 38
Not married 53 53
Widowed 2 2
Divorced 7 7
Women who have ever been pregnant
Ever pregnant 63 63
Number of pregnancies
1 or 2 pregnancies 41 65.1
3 or more pregnancies 22 34.9
Number of births
1 – 2 births 29 72.5
3 or more births 11 27.5
Source: field data, 2023

4.2: Women's Knowledge, level of knowledge and source of information on contraceptives

Figure 2 presents findings on contraceptive knowledge, level of knowledge and source of

information on contraceptives. Gaining knowledge on contraceptives can determine its use.

35
All the women had knowledge on at least one method of contraceptive with majority 58 (58.0%)

having high knowledge which means that they had knowledge on 6-7 methods of contraceptives.

Medium knowledge (knowledge on 3-5 methods) and low knowledge (knowledge on 1-2

methods) were 38 (38.0%) and 4 (4.0%) respectively. Of all women, 78 (78.0%) had knowledge

on at least one method of contraception out of the 7 methods whiles 22 (22.0%) had knowledge

on 6 – 7 methods of contraception. Women who had knowledge on 1 to 5 methods were

classified under having some knowledge. This distribution implies that there is universal

knowledge on at least one method of contraceptive.

Nearly half of the participants 47 (47.0%) had their information on contraceptives from health

workers whereas 28 (28.0%) got informed by friends. Also, 20 (20.0%) had information from the

mass media whiles information from neighbors and relatives represented 3 (3.0%) and 2 (2.0%)

respectively.

Figure 1: women’s level of knowledge on contraceptives

LEVEL
70
OF KNOWLEDGE ON CONTRACEPTIVES
60 58

50

40 38

30

20

10 4
0
level of
knowledge
on contra-
ceptives
Low Medium High

Low: Heard of 1-2 contraceptive methods

36
Medium: Heard of 3-5 contraceptive methods

High: Heard of 6-7 contraceptive methods

Figure 2: women’s knowledge on contraceptives

KNOWLEDGE ON CONTRACEPTIVES
90

80 78

70

60

50

40

30
22
20

10

0
Knowledge on contraceptive

knowledge on some methods knowledge on all methods

37
Figure 3: Women’s source of information on contraceptives

SOURCE OF INFORMATION ON CONTRACEPTIVES

50 47
45
40
35
30 28
25
20
20
15
10
5 2 3
0
Source of information on contraceptives

friend relative neighbor health worker mass media

4.3 Use of contraceptives among respondents

All the women interviewed were asked about ever use and current use of contraceptives. More

than half of the respondents 56 (56.0%) indicated they had ever use a method of contraception at

some point in time while 44 (44.0%) of the women were currently using some method of

contraception, putting the prevalence of contraceptive use among participants in the Municipal at

44.0%. The remaining were not using any method of contraception at the time of study. Reasons

for contraceptive use among current users were Birth spacing 17 (38.6%), limiting birth 6

(13.7%) and to prevent unwanted pregnancy 21 (47.7%).

Among the 44 participants who reported current use, 2 (4.5%) reported using injectable. 10

(22.7%) of them indicated using pill whereas 6 (13.6%) used implant. Among the respondents,

38
condom was a current method used by 3 (6.8%) women, 20 (45.5%) used emergency

contraception, 2 (4.5%) used IUD whiles 1 (2.3%) use withdrawal respectively.

Regarding the source of current contraceptives, 25 (58.1%) of women who are currently using

contraceptives reported that they obtained the method from the public hospital/clinic. It is

obvious services were obtained from government clinics. 3 (7.0%) obtained their services from

outreach services. Pharmacy served as a source of contraceptives for 15 (38.9%) of the

participants.

Concerning preferred method, majority, 46 (46.0%) of women said emergency pill was the most

preferred method whiles 20 (20.0%) said pill was their preferred method most effective

contraceptive. Also, 15 (15.0%) preferred condom whiles 4 (4.0%) and 8 (8.0%) considered

preferred methods to be periodic abstinence and withdrawal respectively. 4 (4.0%) preferred

injection whiles the least figure, 3 (3.0%) considered IUD as their preferred method.

Of the 66 respondents who were not using any method of contraception at the time of the study,

15 (22.7%) reported not being sexually active as a reason for not using. 28 (42.4%) said they

were not using for the fear of side effects. 16 (24.2%) were currently pregnant and indicated that

they were not on any contraception because of the pregnancy whiles 5 (7.6%) of the women

indicated they wanted to get pregnant and so were not using any form of contraception. 2 (3.0%)

were not using contraceptives because of financial problems. These results are presented in table

2 below.

Table 2: Use of contraceptives among women aged 15-40 years

Variable Frequency (n=100) Percent (%)
Ever use of contraception
Women who have ever used contraceptives 56 56.0
Current use of contraception

39
Women currently using contraceptives 441 44.0
Reasons for currently using contraceptives
Birth spacing 17 38.6
Limiting birth 6 13.7
Prevent unwanted pregnancy 21 47.7
Total 44 100
Current contraception method
Injectable 2 4.5
Pill 10 22.7
Implant 6 13.6
Condom 3 6.8
Emergency contraception 20 45.5
IUD 2 4.5
Periodic abstinence 0 0.0
Withdrawal 1 2.3
Total 44 100
Source of contraception among current users
Public hospital/clinic 25 72.1
Outreach 3 7.0
Pharmacy 15 38.9
Peer educator 0 0
Total 43 100

Preferred method of contraception

Injection 4 4.0
Pill 20 20.0
Condom 15 15.0
Periodic abstinence 4 4.0
Withdrawal 8 8.0
Emergency pill 46 46.0
IUD 3 3.0
Women currently not using any contraception
Women not currently using contraceptives 66 66.0
Reasons for currently not using any contraception
Not sexually active 15 22.7
Side effects 28 42.4
Currently pregnant 16 22.2
To get pregnant 5 7.6
Financial problems 2 3.0
Husbands disapproval 0 0.0

40
Total 66 100

4.4 Barriers and enablers of contraceptive use

Identifying barriers and enablers to the use of contraceptives are part of the objective of this

research. Frequencies and percentages are more than 100 and 100% due to multiple responses.

Of all the respondents, 59 (59.0%) responded that contraceptives were not patronized because of

fear of side effects. Lack of confidentiality in service providers was mentioned by 12 (12.0%)

women as a reason for not using contraceptives whiles 11 (11.0%) respondents thought that they

were too young and feared the perception the community will have about them upon seeing them

assessing family planning services. Also, 57 (57%) stated husbands disapproval as a barrier to

contraceptive use whiles 4 (4.0%) said it was due to personal issues.

Distance to access service was a reason stated by 8 (8.0%) of the women, provider attitude was a

barrier identified by 12 (12.0%) of the women whiles religious restriction was mentioned by 13

(13.0%) of women as reason for non-use. Of all respondents, 24 (24.0%) stated that

uncomfortable examination done before service is rendered is a reason for contraceptive non-use,

whiles 26 (26.0%) mentioned that service providers ask for the presence of husbands before

rendering service which served as a barrier whereas 16 (16.0%) said husbands/partners were the

main decision makers when it is about contraceptive use. Other family members especially

mothers and mother in-laws made decisions for some women and this was a barrier stated by 15

(15.0%) women whiles 28 (28.0%) said some husbands wanted more children and so that

prevented women from using contraceptives.

Regarding enablers, almost all participants 86 (86.0%) established that contraceptives were

affordable to them which motivated women to use contraceptives whiles 64 (64.0%) of

41
respondents indicated information given by service providers as a motivation to use. Availability

of preferred methods was an enabler to contraceptive use stated by 78 (78.0%) of respondents

whereas information given on actions regarding side effects was indicated by 29 (29.0%)

respondents. Encouragement from friends was stated by 87 (87.0%) as an enabler whiles 46

(46.0%) of the women said that the ability of women to make decisions unanimously without

husbands or family members was a motivating factor. efficacy of contraceptives to prevent

unwanted pregnancy was stated by 42 (42.0%) women as a motivation to use whiles 37 (37.0%)

stated birth spacing as a motivation to use contraceptives. Also, 54 (54.0%) said motivation by

family members was a reason for contraceptives use by some women, 33 (33.0%) stated that

taking decisions with spouses jointly regarding contraception was a motivation. Limiting birth

was a motivation for 14 (14.0%) current users of contraceptives. These results are shown in

Table 3 below.

Table 3: Barriers and enablers of contraceptive use

Characteristics Frequency (n=100) Percent (%)

Barriers

Side effects 59 59.0

Lack of confidentiality 12 12.0

Perception about age and 11 11.0

contraceptive use

Husbands disapproval 57 57.0

Other personal issues 4 4.0

Distance to health facility 8 8.0

42
Provider attitude 12 12.0

Religious restrictions 13 13.0

Examination done which women 24 24.0

are not comfortable with

Request husband’s presence 26 26.0

Mainly husband’s/partners 16 16.0

decision to use contraceptives

Decision on contraceptives use 15 15.0

made by other family members

Husband wants more children 28 28.0

Enablers

Birth spacing 37 37.0

Limiting birth 14 14.0

Prevent unwanted pregnancy 42 42.0

Effectiveness 6 6.0

Affordability of contraceptives 86 86.0

Availability of preferred 78 78.0

contraceptive methods

Information given on side effects 29 29.0

by service providers

Information given on action of 21 21.0

side effects

43
Encouragement from friends to 87 87.0

use contraceptives

Encouragement from family 54 54.0

members to use contraceptives

Mainly respondent 46 46.0

Joint decision to use 33 33.0

contraceptives

CHAPTER FIVE

5.0 DISCUSSION

The findings of the study are discussed in this chapter. The findings are situated in the context of

existing literature.

This study sought to explore the utilization of contraceptives among women of reproductive age

in Salaga Municipality by identifying some enablers and barriers. The study population

comprised only of women aged between 15-40 years. More than three quarters (78%) of these

44
women were below 30 years, this failed to mirror the population structure and age distribution of

Ghana as indicated by (GSS et al., 2015) to be 52%. The increase in this study could be due to

time interval between GDHS study and current study.

5.1 Knowledge on contraceptives

Knowledge of contraceptives is key in determining its use, therefore, every attempt to assess

barriers to contraceptive use ought to consider existing knowledge (Sedgh et at., 2017). Low or

no knowledge on contraception influences its use in one way or the other.

Generally, global contraceptive knowledge is high. The USAID demographic and health survey

declared contraception knowledge almost universal (Khan, Mishra, Arnold, & Abderrahim,

2017). This conforms to the findings of this study which realized that contraception knowledge

was universal among respondents (100%). All women interviewed knew about at least one

method of contraception putting the knowledge of at least one method of contraceptives at 100%

in this study which is not so different from the 99% knowledge level on at least one

contraception method determined in the (GSS et al., 2015). Knowledge on only one method of

contraception is enough to make fertility choices/decisions. However, this high knowledge did

not reflect in contraceptive use among respondents with 56.0% of respondents reporting ever use

while only 44.0% were currently using contraceptives at the time of study. The Ghana

Demographic and Health University of Survey (2015) study similarly found that although there

was high knowledge, current use of contraceptives was 23% among all women. This is in line

with the conclusion that although knowledge on contraceptives improve use, it does not assure

use because many have knowledge yet do not use (Cheng, 2011; Lamvu, Steiner, Condon, &

Hartmann, 2006; Mekonnen, Enquselassie, Tesfaye, & Semahegn, 2014).

45
5.2 Prevalence of contraceptive use

It was surprising to find that the high levels of knowledge on contraceptives (100%) did not
reflect in its current use (44.0%). This is confirmed by a study findings that the high knowledge
on contraceptives in developing countries do not always result to high usage (Sedgh et al., 2017).
The study found the prevalence of current use of contraceptives to be 44.0% whiles that of ever
use stood at 56.0%. This indicates that the prevalence of contraceptive use in this study is 44.0%
which is different from the contraceptive prevalence rate (CPR) determined in the Ghana
Demographic and Health Survey 2014 as 23% (Ghana Statistical Service, 2015). This could be
due to the time interval between the two studies. Between 2014 when GDHS study was
conducted and 2016 when current study was conducted, several interventions to educate people
about contraceptives took place which could have promoted its use. The observed rate in this
study is also not so different from a study undertaken by Lauria et al., (2014) in Italy which
found CPR to be 65%. The differences in CPR established in this study and that of Italy can
partly be attributed to the family planning seeking behavior, where in Ghana, women still seek
family planning services secretly, not wanting people to know whereas in Italy, contraceptive use
is discussed publicly.

This study discovered that among the methods used, emergency contraception (45.5%), oral pill
(22.7%) and implant (13.6%) were the methods mostly used. This again is comparable to the
findings of GSS (2015) where emergency contraception, oral pill and implant were the
commonest methods used. Condom was the fourth highest (6.8%) method used by women in this
study. In the study, withdrawal was 2.3 % as compared to condom use being 6.8%, this is
contrary to the findings that withdrawal method is used more than condom where GSS (2015)
reported withdrawal as 3.2% and condom use as 2%.

It has been reported in a study in southern Ghana that, family planning services are accessed and
used by women in secret. This is because their partners refused to consent to its use (Adongo ct
al., 2013). Marital status was found to be associated with current use of contraceptives. A study
conducted in the US found that married women were more likely to use contraceptives with
reasons of being able to take good care of their children than unmarried women (Parnell &
National Research Council, 1989). Adanu et al. (2009) in their Accra population study found that
women (both married and unmarried) who had more sexual partners were significantly more

46
likely to use contraceptives than those with just one sexual partner. This was regardless of
marital status but number of sexual partners (Adanu et al., 2009).

5.3 Barriers and enablers of contraceptive use

Barriers, according to Shelton et al., (1992) are practices or reasons that deny people from

accessing family planning services despite their wish for it (Shelton et al., 1992). Enablers are

those that promote contraceptive use. Identifying Barriers and enablers was the main focus of

this study. Barriers were obtained from questions regarding contraceptive current non-use and

factors preventing other women from using it whiles enablers were discussed under reasons for

current use of contraceptives and reasons why other women used it. In this study, it was revealed

that 66.0% of the respondents in Salaga municipality were currently non-users of contraceptives.

In this study findings, a regular trend observed was fear of side effects as a reason for not using

contraceptives. 59.0% of all participants indicated side effects as a reason for non- use of

contraceptives. This supports a study in Malawi which showed that perceptions of side effects,

such as prolonged menstruation, infertility and genital sores, weight gain or loss, and high blood

pressure hindered contraceptives use (Chipeta et al., 2010). Information about side effects

dictates contraceptive use (Sedgh & Hussain, 2014) although studies have shown that clients

who received counseling on side effects were more likely to use contraceptives (Darroch &

Singh, 2013; Darroch, 2013; Sedgh & Hussain, 2014). This also supports the findings of the

2014 Ghana Demographic and Health Survey which stated fear of side effects as a reason for

contraceptive non-use (Ghana Statistical Service, 2015). It has similarly been stated that the fear

of side effects or experienced side effects is a barrier to contraceptive use (Campbell et al.,

2006).

47
The study realized that service provider attitude towards choice of method was a barrier although

not a major one. It is backed by a study which discovered that service providers impede

contraceptives use (Karavus et al., 2014). They introduce bias by dictating the method to be

useful to clients either clearly or by implications is an attitude which also affects contraceptive

use (Nalwadda, Mirembe, Byamugisha, & Faxelid, 2018).

Religious restrictions accounted for reasons for not using contraceptives as indicated by 13

(3.0%) of all respondents. The findings of this study confirms one that was done in Pakistan by

Farid-ul-Hasnain, Johansson, Gulzar, & Krantz, 2013; Sahu & Hutter, (2012), where it was

stated that religion is an important influence on the knowledge and use of contraceptives. In a

contrasting view, a study conducted in Ghana showed that religion did not affect contraceptive

use (Tawiiah, 2016; Adanu et al., 2019). Also, Doctor et al. (2019) found that switching from

traditional to the Christian or Islamic faith in the Kassena- Nankana area of Upper East region of

Ghana was significantly associated with increased contraceptive use and decreased fertility

(Doctor et al., 2019) which may be because of the findings of a study done in Ghana which

stated that there is fear of ancestral punishment with the use of contraceptives and for the fear of

death, women do not use it even if they need it (Bawah et al., 2016).

Almost 50% of these current users used it with the reason to prevent unwanted pregnancy.

This is similar to the findings by Mon & Liabsuetrakul, (2012) which had an association with of

exposure to unintended pregnancy with contraceptive use. These findings contradicts another

study which revealed that perceptions about susceptibility to unintended pregnancy did not

translate in contraceptive use. (Rahman, Berenson, & Herrera, 3013). These observed differences

could be due to identified barriers facing partners including fear of side effects as stated by many

in this study. The reasons of using contraceptive to prevent unwanted pregnancy supports the
48
study which said that use of contraceptives reduces economic burden by reducing unintended

pregnancies (Parnell & National Research council, 2014) . Majority of current users (38.6%)

indicated birth spacing as a reason for use whiles 13.7% used it to limit birth. This finding agrees

to that of GDHS (2018) which says that the primary use of contraceptive is limiting and spacing

of birth.

5.4 Limitations of the study

The study findings are established from two communities making it challenging to generalize the

findings to all women of reproductive age in the region and in Ghana. Also, the quantitative

method that was used in the study did not allow the researchers to collect in-depth information

from respondents.

CHAPTER SIX

6.0 Conclusions

The objectives of this study were to assess the knowledge of contraceptives among women of

reproductive age. To determine the prevalence of contraceptive use among women of

reproductive age and identify factors serving as enablers and barriers to contraceptive use.

49
In connection with objective one, knowledge on contraceptives was universal with all women

knowing of at least one method of contraception. The study found that the major sources of

information about contraceptives was from health care providers, friends and mass media.

Regarding objective two, use of contraceptive was prevalent in more of the study population.

Close to 60% had ever used contraceptives while 44% women were currently using

contraceptives at the time the study was conducted. Use of emergency contraception (45.5%) and

oral pill (22.7%) were the commonest used among participants. The leading barrier to

contraceptive use was fear of side effects whiles the primary enabler of use is the fact that

contraceptives are affordable.

6.1 Recommendations

Based on the findings of this study, it is important that different approaches be used to improve

contraceptive use among women of reproductive age. The following recommendations are

suggested.

6.1.1 Practice

1. Fear of side effects was a major barrier identified in the study. Messages should be

developed and disseminated to women by the Municipal Health Directorate to reduce the

level of fear about contraceptive use.

2. The Municipal Health Directorate should conduct surveys periodically to identify some

attitudes of service providers which discourage women from accessing contraceptives.

This would help address negative provider attitude and increase the prevalence of the use

of contraceptives.

50
6.1.2 Policies

1. Health care providers, friends and mass media are the major sources from which

awareness on contraceptives is obtained, therefore, the Ghana Health Service (GHS)

should have a policy on how to reach out to people with in-depth knowledge on the

benefits of contraceptive use and barriers to contraceptive use through these groups.

6.1.3 Research

1. Further research on contraceptive use should be conducted extensively and should

involve a larger sample size so as to make it possible to generalize findings to all women

of reproductive age.

2. Due to the fact that this research was not qualitative, further research using qualitative

method should be conducted to further ascertain reasons accounting for use and non-use

of contraceptives among women of reproductive age.

REFERENCES

Achana, F. S., Bawah, A. A., Jackson, E. F., Welaga, P., Awine, T., Asuo-Mante, E., Phillips, J.

F. (2015). Spatial and socio-demographic determinants of contraceptive use in the Upper

East region of Ghana. Reproductive Health, 12(1), 29.

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Bawah, A. A., Phillips, J. F., & Wak, G. (2015). Does Women's Relative Income Predict

Contraceptive use in Ghana? An Assessment Using Bargaining Theory. In XXV

International Population Conference (p. 4). Tours, France: Princeton University.

Campbell, M., Sahin-Hodoglugil, N. N., & Potts, M. (2016). Barriers to fertility regulation: a

review of the literature. Studies in Family Planning, 37(2), 87–98.

Darroch, J. E. (2013). Trends in contraceptive use. Contraception, 87(3), 259-263.

Doctor, H. V, Phillips, J. F., & Sakeah, E. (2019). The Influence of Changes in Women’s

Religious Affiliation on Contraceptive Use and Fertility Among the Kassena-Nankana of

Northern Ghana. Studies in Family Planning, 40(2), 113-122.

Edgerton, D. (2011). Shock of the Old: Technology and Global History Since 1900. Profile

books.

Farid-ul-Hasnain, S., Johansson, E., Gulzar, S., & Krantz, G. (2013). Need for multilevel

strategies and enhanced acceptance of contraceptive use in order to combat the spread of

HIV/AIDS in a Muslim society: a qualitative study of young adults in Urban Karachi,

Pakistan. Global Journal of Health Science, 5(5), p57.

Frost, J. J., Singh, S., & Finer, L. B. (2017). Factors associated with contraceptive use and

nonuse, United States, 2004. Perspectives on Sexual and Reproductive Health, 39(2), 90-

99.

Ghana Statistical Service (GSS), Ghana Health Service (GHS), & ICF Macro. (2015).

Ghana Demographic and Health Survey 2014: Key Indicators. Accra, Ghana.

reproductive health: a matter of life and death. The Lancet, 368(9547), 1595-1607.

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Greene, E., & Stanback, J. (2012). Old barriers need not apply: opening doors for new

contraceptives in the developing world. Contraception, 85(1), 11-14.

Izale, K., Govender, I, Fina, J.-P. L., & Tumbo, J. (2014). Factors that influence contraceptive

use amongst women in Vanga health district, Democratic Republic of Congo. African

Journal of Primary Health Care & Family Medicine, 6(1), 1-7.

Jayaraman, A., Mishra, V., & Arnold, F. (2019). The relationship of family size and composition

to fertility desires, contraceptive adoption and method choice in South Asia. International

Perspectives on Sexual and Reproductive Health, 29-38.

Kamhawi, S., Underwood, C., Murad, H., & Jabre, B. (2013). Client-centered counseling

improves client satisfaction with family planning visits: evidence from Irbid, Jordan.

Global Health: Science and Practice, 1(2), 180-192.

Levin, A., Amin, A., Rahman, A., Saifi, R., Khuda, B., & Mozumder, K. (1999). Cost-

effectiveness of family planning and maternal health service delivery strategies in rural

Bangladesh. The International Journal of Health Planning and Management, 14(3), 219-

233.

Nalwadda, G. K. (2012). Contraceptive Use among Young People in Uganda: Exploration of

obstacles, enablers, and quality of services.

Reher, D. S. (2004). The demographic transition revisited as a global process. Population Space

and Place, 10(1), 19-41.

Reuben, A. (2004). Hepatology, 39(6), 1750-1753.

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Saha, U. R., & Bairagi, R. (2007). Inconsistencies in the relationship between contraceptive use

and fertility in Bangladesh. International Family Planning Perspectives, 33(1), 31-37.

Shelton, J. D., Jacobstein, R. A., & Angle, M. A. (1992). Medical barriers to access to family

planning. The Lancet, 340(8831), 1334-1335.

Tadesse, M., Teklie, H., Yazew, G., & Gebreselassie, T. (2013). Women's Empowerment as a

Determinant of Contraceptive use in Ethiopia. DHS Further Analysis Reports No.

82.Calverton, Maryland, USA.

World Health Organization - WHO. (2014). World health statistics 2013. Geneva, Switzerland:

World Health Organization. wus, 0. (2014). Religious influence on non-use of modern

contraceptives among women in nigeria: comparative analysis of 1990 and 2008 ndhs.

journal of biosocial science, 1-20.

APPENDIX I

QUESTIONNAIRE

QUESTIONNAIRE ON UTILIZATION OF CONTRACEPTIVES AMONG WOMEN OF

REPRODUCTIVE AGE IN SALAGA MUNICIPALITY

Instructions to the interviewer:

54
1. Circle or tick the response or write in the space provided.

2. Be keen to follow the skip patterns.

3. Countercheck to ensure all the relevant questions are completed.

SECTION 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS

1. How old were you on your last birthday? ..........................................................

2. What is the highest level of school you attended?

a. Primary

b. Middle

c. JHS

d. SHS

e. Tertiary

3. What is your current employment status?

a. Employed

b. Unemployed

4. What is your religion?

a. Christian
b. Muslim
c. Traditionalist
d. No religion
5. What is your current marital status?

a. Married
b. Not married
c. Widowed
d. Divorced
6. Have you ever been pregnant?

55
 a. Yes
b. No

If no, skip to question 11

7. How many pregnancies have you had in your lifetime? (Include miscarriages, abortions

and stillbirth)………………………………………………….

8. How many births have you had? (Both living and dead)..........................................

9. When you got pregnant, did you want to get pregnant at that time?

a. Yes
b. No
10. Are you currently pregnant?

a. Yes
b. No

SECTION 2: CONTRACEPTION KNOWLEDGE AND PREVALENCE

11. Have you used a family planning method before?

a. Yes
b. No
12. If Yes, Which family planning method have you ever used? CIRCLE ALL THAT

APPLY

a. Oral pill
b. Emergency pill
c. Condom
d. IUD
e. Implant
f. Injectable
g. Withdrawal.
h. Emergency Contraception

56
 i. Others (specify) ……………………………….
13. Are you currently using any Family Planning method or doing something to delay or

avoid getting pregnant? If No, skip to question 14 - 16

a. Yes
b. No
14. Which method are you currently using?

a. Oral pill

b. Emergency contraceptive

c. Condom

d. IUD

e. Implant

f. Injectable

g. Sterilization/permanent

h. Withdrawal

i. Others (Specify) …………………………………………

15. Where did you obtain the method from?

a. Public Hospital/clinic
b. Fieldworker/outreach/
c. Private hospital/clinic
d. Pharmacy/chemical store
e. Other (specify)
16. What are you using your preferred method to achieve?

a. Birth spacing
b. Limiting birth
c. Prevent unwanted pregnancy
d. Others (Specify) …………………………….

57
17. If No to question 13, why?

a. To plan pregnancy
b. Not sexually active
c. Side effects
d. Opposition from husband
e. Financial problem
f. Lack of knowledge
g. Religious restrictions
h. Lack of access
i. Others (Specify) ……………………………………

SECTION 3: FACTORS SERVING AS ENABLERS OR BARRIERS TO

CONTRACEPTIVE

18. Do you think Family Planning products and services are affordable in Government health

facilities in this community?

a. Yes
b. No
19. Are your preferred methods always available at the health facility?

a. Yes
b. No
20. Do FP service providers usually tell you the side effects or problem you may encounter

with your method of choice?

a. Yes
b. No
21. Do they usually tell you what to do if you experience side effect or difficulty?

a. Yes

58
 b. No
22. Do service providers ask you to do laboratory test or any other test/examination that you

are not comfortable with?

a. Yes
b. No
23. Do service providers request you to bring your husband before you obtain your preferred

method?

a. Yes
b. No
24. Do you discuss family planning issues with your friends?

a. Yes
b. No
25. Do they encourage discourage its use?

a. Encourage
b. Discourage
26. Do you discuss family planning issues with your family members?

a. Yes
b. No
27. Would you say that using contraception is mainly your decision, mainly your

(husband's/partner's) decision, or did you both decide together?

a. Mainly respondent
b. Joint decision
c. Mainly husband/partner
d. Other (specify) …………………………………………………
28. Does your (husband/partner) want the same number of children that you want, or does he

want more or fewer than you want?

a. Fewer children

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 b. Same number
c. Don't know
d. More children
29. Do family members encourage the use of Family Planning methods?

a. Yes
b. No
30. What are some of the factors that prevent you and other women from accessing family

planning service?

……………………………………………………………..

…………………………………………………………….

……………………………………………………………

……………………………………………………………..

31. Which factors motivate you and other women to use family planning methods?

………………………………………………………………

………………………………………………………………

……………………………………………………………..

……………………………………………………………….

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